Tuesday, 29. September 2009

Expert Opinion: Holding Chambers for patients of all ages

Two Italian physicians reported in the scientific journal “Expert Opinion on Drug Delivery” on their experiences in inhalation therapy [1]. Their policy in daily practice is to use holding chambers together with asthma inhalers for the whole spectrum of the patient population.

They particularly recommend antistatic valved holding chambers – like VORTEX – across the entire range of age groups from infants to the elderly. This procedure is not only based on their personal experience but also supported by scientific studies. Those demonstrated that only few patients are capable of correctly performing all steps that are necessary for effective inhalation therapy when using an asthma inhaler [e.g. 2,3].

Holding chambers constitute a volume between the asthma inhaler and the patient’s mouth, where the “aerosol cloud” can develop. After firing the inhaler into the chamber, the drug may be inhaled deeply and slowly without necessarily coordinating the two manoeuvres. This renders the inhalation a lot easier and – as generally faultless – also significantly more reliable. Moreover droplets, that are too big to reach the lungs, will deposit in the holding chamber and only the fine particles are breathed in. This leads to less drug deposition in the mouth and throat and hence to less adverse reaction in this region while the lung dose remains high. Thus patients may benefit more from therapy with asthma inhalers when using a holding chamber.

[1] Lavorini & Fontana 2009 Expert Opin Drug Deliv 5(1): 91
[2] Molimard et al. 2003 J Aerosol Med 16(3): 249
[3] Kamps et al. 2000 J Pediatr Pulmonol 29(1) : 39